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Inspection on 12/01/06 for Sundridge Court Nursing Home

Also see our care home review for Sundridge Court Nursing Home for more information

This inspection was carried out on 12th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The Peripatetic manager and care staff have worked hard to ensure service users have received continuity of care and service during the change of ownership between companies. Appropriate training is provided to meet the health, safety and care needs of service users and staff working in the home. There are a sufficient number of suitably qualified and competent staff employed to provide care to service users. Service users can be assured their privacy and dignity will be respected by staff working in the home. The home employs an activity co-ordinator and service users have the opportunity to participate in a variety of social activities. The home has secured the support of advocacy services for service users and their relatives needing advice and support.Service users are able to live in a clean, comfortably homely environment.

What has improved since the last inspection?

Action has been taken to address issues raised at the previous inspection regarding recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The registered person has taken action to prevent infection and spread of infection in the care home, by removing cream and soap from bathrooms, which may be used by more than one service user. The peripatetic manager has established a system to review at appropriate intervals and improve the quality of care provided in the care home, including the quality of nursing care provided. Systems have been put in place to enable service users to have a small amount of personal allowance held in the home. A more comprehensive system of care planning has been introduced.

What the care home could do better:

The manager was asked to take action regarding one of the homely remedies (simple linctus), as it was found to be out of date, also eye drops had not been dated on opening. The Statement of Purpose and Service User Guide for the home needs to be altered to reflect the changes in ownership of the home and its care, services policies and procedures. The manager needs to obtain an up to date copy of the electrical safety certificate of the home, which must to be available for the next inspection.

CARE HOMES FOR OLDER PEOPLE Sundridge Court Nursing Home 19 Edward Road Bromley Kent BR1 3NG Lead Inspector Lorraine Pumford Unannounced Inspection 12th January 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Sundridge Court Nursing Home DS0000010144.V275252.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Sundridge Court Nursing Home DS0000010144.V275252.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Sundridge Court Nursing Home Address 19 Edward Road Bromley Kent BR1 3NG Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8466 6553 020 8466 5180 Harley Healthcare Nursing Homes Limited Mrs Norah Davey Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (29), Physical disability (1) of places Sundridge Court Nursing Home DS0000010144.V275252.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Staffing Notice issued 18 December 1998 Date of last inspection 17th August 2005 Brief Description of the Service: Sundridge Court is situated in a quiet residential area of Bromley. It is a purpose-built home providing nursing care for up to thirty older people. The home has twenty-four single bedrooms and three shared bedrooms. All bedrooms have en-suite facilities. A passenger lift provides access to all floors. Communal space includes a lounge, large conservatory and a dining room. There is a laundry on-site. The home has a large back garden with patio seating and there is some off-street parking at the front of the building. A bus route and Sundridge Park rail station are within reasonable walking distance for those with full mobility. Sundridge Court Nursing Home DS0000010144.V275252.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by two inspectors who spent a morning in the home, during that time a number of service users, staff and the peripatetic manager were spoken with, a number of records were examined and parts of the premises inspected. The key standards still out standing from the previous inspection and required to be inspected within a 12 month period were examined during this inspected, the report also includes information provided by service users, staff and the manager and observation made regarding changes to the environment, policies and procedures. Since the last inspection Sundridge Court Nursing home has changed ownership from Harley Healthcare Nursing Homes Limited, to Caring Homes Limited. The previous registered manager has left and the new providers have arranged for a peripatetic manager to over see the initial implementation of the companys policies and procedures in Sundridge Court. What the service does well: The Peripatetic manager and care staff have worked hard to ensure service users have received continuity of care and service during the change of ownership between companies. Appropriate training is provided to meet the health, safety and care needs of service users and staff working in the home. There are a sufficient number of suitably qualified and competent staff employed to provide care to service users. Service users can be assured their privacy and dignity will be respected by staff working in the home. The home employs an activity co-ordinator and service users have the opportunity to participate in a variety of social activities. The home has secured the support of advocacy services for service users and their relatives needing advice and support. Sundridge Court Nursing Home DS0000010144.V275252.R01.S.doc Version 5.1 Page 6 Service users are able to live in a clean, comfortably homely environment. What has improved since the last inspection? What they could do better: The manager was asked to take action regarding one of the homely remedies (simple linctus), as it was found to be out of date, also eye drops had not been dated on opening. The Statement of Purpose and Service User Guide for the home needs to be altered to reflect the changes in ownership of the home and its care, services policies and procedures. The manager needs to obtain an up to date copy of the electrical safety certificate of the home, which must to be available for the next inspection. Sundridge Court Nursing Home DS0000010144.V275252.R01.S.doc Version 5.1 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Sundridge Court Nursing Home DS0000010144.V275252.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sundridge Court Nursing Home DS0000010144.V275252.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, The Statement of Purpose and Service User Guide for the home need to be altered to reflect the changes in ownership of the home and its care, services policies and procedures. EVIDENCE: The Company will have to ensure that the Statement of Purpose and Service Users’ Guide are altered to include the new details of the Company and management; and add in to these documents the changes, which have been implemented. (Where applicable). Sundridge Court Nursing Home DS0000010144.V275252.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Service users can be assured staff will respect their privacy and dignity. There are detailed records regarding service users assessed needs with clear aims and objectives and guidance for service users and staff regarding action to be taken to meet these. EVIDENCE: The company are introducing a new pre admission assessment and care plan format; a copy of this was examined. One completed form was seen, this contained good details and included assessments regarding nutrition, personal care, nursing needs, medication, moving and handling, continence, pressure area care, social and cultural needs, and risk assessments. The new Manager had been unable to locate records of drug reviews and has already arranged a visit from the Pharmacist to check practices and procedures within the home. Changes in documentation have been implemented to include a system for recording any verbal orders given by a GP, and to send a fax for the GP’s signature for confirmation of any changes. Sundridge Court Nursing Home DS0000010144.V275252.R01.S.doc Version 5.1 Page 11 A new form was being set up to assess any Service User wishing to self medicate, so that it can be clearly established that they are able to fully understand their medication and manage the process without support. One of the Inspectors checked the medication storage and administration. Medication is administered via a monitored dosage system and is stored in a locked trolley within a locked clinical room. The room is fitted with sufficient metal cupboards to ensure separate storage for internal and external medication. Cupboards were in good order, with no overstocking. The drugs fridge was being used for the correct medicines, and the temperature is recorded daily. Medicine Administration Records (MAR charts) were viewed and were mostly well completed, except for one or two signatures missing. This was discussed to the Manager. MAR charts included a recent photograph of each Service User. Handwritten entries were properly signed and dated. Controlled drugs were stored correctly, and the controlled drugs register had been properly completed. One of the homely remedies (simple linctus) was out of date, and eye drops had not been dated on opening. Service Users expressed their contentment with living in the home and one said, “the carers are marvellous – always there for us”. They are able to sit in the lounge or conservatory or their own rooms, according to choice. One Service User was still in bed, and the staff confirmed that Service Users are able to get up or go to bed at the times they prefer. Staff were seen to have gentle and caring attitudes, and to ensure Service Users privacy and dignity are protected. Service Users were well groomed, and dressed in suitable clothing for the time of year. Sundridge Court Nursing Home DS0000010144.V275252.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,14, Service Users can be assured they will have opportunities to participate in appropriate and meaningful social activities. EVIDENCE: The previous Activities Co-ordinator has recently left and the Manager has appointed a new Activities Co-ordinator, who has previously carried out care in the home. This provides the advantage of already knowing most of the Service Users, and their preferred activities. Individual and group activities were being arranged, and care staff were assisting Service Users with specific tasks such as letter writing. This was particularly applicable after Christmas, when many Service Users wanted to write thank you letters to friends and relatives. Although service users stated they were aware of changes in relation to the ownership and management of the home, they did not feel this had been detrimental to them and service users felt the care and service provided had remained consistent. Service users spoken with stated they had been given the opportunity to bring in personal possession and mementos from home to personalise their bedrooms in the Sundridge Court. Sundridge Court Nursing Home DS0000010144.V275252.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17 An advocacy service is provided to ensure service users are aware of their rights and to provide general guidance for service users and staff. EVIDENCE: Service users names are on the electoral role and arrangements have been made to enable postal votes to be made at the time of elections. The manager stated that a local community advocacy group have been contacted to provide help and support to any service user specifically requiring their input and to provide general guidance for service users and staff. Sundridge Court Nursing Home DS0000010144.V275252.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,24,26 Service users are provided with a safe, clean and homely environment. The home provides appropriate equipment to meet the needs of the service users accommodated. Sound procedures are in place to prevent the risk of infection. EVIDENCE: The Manager showed the Inspectors around the home, pointing out changes already made, and plans for future changes. The home was generally well maintained and décor, furniture and furnishings are of good quality. The maintenance man was busy carrying out minor repairs, and routine checks. The Manager has altered the reception and part of the lounge area to provide a more homely feel, and to provide an area for visitors to sit when visiting Service Users. Sundridge Court Nursing Home DS0000010144.V275252.R01.S.doc Version 5.1 Page 15 Communal areas are rather limited for this number of Service Users, but have been enhanced by the addition of a conservatory. This leads out from a large lounge, and a small dining area. As many Service Users need nursing care, many cannot sit comfortably at a dining table and have their meals seated in armchairs in the lounge, or in their own bedrooms. The home has en-suite toilet facilities for all bedrooms. There are 2 bathrooms, which are fitted with “Parker” baths, suitable for the Service Users. The Manager is considering altering a disabled toilet on the first floor into a walk- in shower room, so that Service Users could have more choice. Each bedroom is fitted with a private telephone and a television set and Service Users are assisted with these as necessary. The home was seen to have suitable equipment in place, including 2 mobile hoists and a stand-aid hoist. All floors can be accessed via a passenger lift and there are grab rails situated as necessary. Other aids include raised toilet seats, commodes, assisted baths and a call bell system in every room. Wheelchairs are cleaned and serviced by the maintenance man as necessary. Several bedrooms were viewed, and were well decorated, clean and tidy, with good quality furniture and furnishings. They are cleaned and dusted every weekday and en-suite toilet areas are cleaned and mopped. Bedroom carpets are cleaned by domestic staff as needed. The home was generally clean throughout and there were no offensive smells. A laundry person is employed to launder all bed linen, towels and personal laundry. The home is fitted with 2 sluices; these are fitted with sluicing disinfectors, for the effective cleaning of commode buckets. Sundridge Court Nursing Home DS0000010144.V275252.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Suitably qualified and competent staff are employed in sufficient numbers to meet the needs of service users. Staff are provided with training opportunities suitable to the tasks they are required to perform. EVIDENCE: The home is staffed with 1-2 nurses for each day shift, and a suitable number of care staff to ensure that they can carry out personal care properly and without rushing Service Users. There are usually 7 care staff on morning shifts, and 5 for the afternoon shifts. Several Service Users usually need assistance with meals and drinks, and this number of staff ensures that they are given adequate personal attention. One nurse and one carer staff night shifts. Daily ancillary staff include 3 cleaners, a cook, an administrator and laundry assistant. The new Manager has not had to recruit any new staff since commencing her post, but has noted that existing staff files need re-organising. The Inspectors discussed some aspects of recruitment, and were able to see confirmation that all staff have had CRB (Criminal Record Bureau) checks carried out. The Inspectors were unable to check details regarding staff training, as the Manager was in the process of setting up a staff-training matrix, this will Sundridge Court Nursing Home DS0000010144.V275252.R01.S.doc Version 5.1 Page 17 enable authorised people to see that all mandatory training has been completed. The Inspectors were pleased to see that more training was being made available for nurses, ensuring that they keep up to date. Courses had already been arranged for venepuncture training (taking blood), and for specific bandaging training (compression bandaging) for Service Users with leg ulcers. Staff spoken with had completed or were undertaking NVQ in care level 2 or 3. Staff confirmed they had received training regarding moving and handling, fire safety and whistle blowing. Some issues were raised by staff to one of the inspectors regarding possible changes in policies between the companies, primarily regarding issues around moving and handling, this was fed back to the manager who said all staff were being taken through the new Company’s own induction programme which was due to commence imminently. Sundridge Court Nursing Home DS0000010144.V275252.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,35,38 There are relevant policies and procedures in place to safeguard service users and staff working in the home. EVIDENCE: The Acting Manager was providing a clear sense of leadership in the home, and was enabling staff to have opportunity at staff meetings to discuss the changes, and take part in ideas for improvements. The new company arranged a Christmas party for all staff and their families, staff spoken with stated how much they had enjoyed and appreciated this. The manager also stated she has arranged for membership for staff to a local gym. Sundridge Court Nursing Home DS0000010144.V275252.R01.S.doc Version 5.1 Page 19 A keyworker system is in place for care staff, and changes are being made to enable staff to take more responsibility and have greater awareness of individual Service Users’ needs. Relatives had been informed of the change of management and ownership of the home, and had been invited to meet with the Manager and staff to discuss changes. The Manager intends to have relatives’ meetings at regular intervals, and to ensure that they are able to take part in the life of the home, and the support of the Service Users. The first meeting is going to include a buffet supper. The Manager speaks with Service Users every day when she is on duty, and ensures they have the opportunity to talk with her about any concerns or ideas. Service Users did not previously have personal money available in the home. The new Manager has implemented a system to enable them to have a small amount of personal allowance available, which is stored safely on the premises. This allows for more independence in buying small items, and the dignity and opportunity of buying items without always relying on staff or relatives to assist them. Each Service User’s money is kept in a separate wallet, with an account held of each purchase or transaction. Money taken out is signed for by 2 senior staff, and by the Service Users themselves where possible. Updated staff training had been implemented for all mandatory subjects. The Manager was able to state that 75 of staff had gone through updated fire awareness training, and most were in the process of going through updated moving and handling training. Six carers hold a first aid certificate. New procedures had been put in place to lessen the numbers of staff going in and out of the kitchens; this is to assist in food hygiene and infection control. COSHH leaflets were available for all chemicals used in the home, and staff know where these are kept. Water temperatures are randomly checked by the maintenance man, to ensure that thermostats are working correctly Accident records were viewed and were completed accurately and with sufficient detail. The format complied with the Data Protection Act. The Manager had commenced carrying out an audit each month of any accidents, so that any pattern of accidents can be quickly noted and preventative action taken. Sundridge Court Nursing Home DS0000010144.V275252.R01.S.doc Version 5.1 Page 20 It was not possible to ascertain from the records seen if the work identified as required at the time the last electrical safety certificate was issued had been addressed. The manager stated this would be followed up and appropriate action taken. Sundridge Court Nursing Home DS0000010144.V275252.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 3 18 x 3 3 3 3 x 3 x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x 3 3 x 3 x x 2 Sundridge Court Nursing Home DS0000010144.V275252.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard 1.1 Regulation OP1 Requirement The Statement of Purpose and Service User Guide for the home need to be altered to reflect the changes in ownership of the home, its care, services policies and procedures. Amended copies need to be circulated to Service users their advocates and the CSCI. Timescale for action 30/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP9 OP38 Good Practice Recommendations One of the homely remedies (simple linctus) was out of date, and eye drops had not been dated on opening. A copy of the homes most recent electrical safety certificate needs to be located and available for the next inspection. Sundridge Court Nursing Home DS0000010144.V275252.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Sundridge Court Nursing Home DS0000010144.V275252.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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